PMID- 33582200
OWN - NLM
STAT- MEDLINE
DCOM- 20210804
LR  - 20210804
IS  - 1532-2939 (Electronic)
IS  - 0195-6701 (Linking)
VI  - 111
DP  - 2021 May
TI  - Successful containment of two vancomycin-resistant Enterococcus faecium (VRE) 
      outbreaks in a Dutch teaching hospital using environmental sampling and 
      whole-genome sequencing.
PG  - 132-139
LID - S0195-6701(21)00063-3 [pii]
LID - 10.1016/j.jhin.2021.02.007 [doi]
AB  - BACKGROUND: Vancomycin-resistant enterococci (VRE) may cause nosocomial 
      outbreaks. This article describes all VRE carriers that were identified in 2018 
      at Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands. AIM: To investigate 
      the genetic relatedness of VRE isolates and the possibility of a common 
      environmental reservoir using environmental sampling and whole-genome sequencing 
      (WGS). METHODS: Infection control measures consisted of contact isolation, 
      contact surveys, point prevalence screening, environmental sampling, cleaning and 
      disinfection. VRE isolates were sequenced using a MiSeq sequencer (Illumina, San 
      Diego, CA, USA), and assembled using SPAdes v.3.10.1. A minimal spanning tree and 
      a neighbour joining tree based on allelic diversity of core-genome multi-locus 
      sequence typing and accessory genes were created using Ridom SeqSphere+ software 
      (Ridom GmbH, Munster, Germany). FINDINGS: Over a 1-year period, 19 VRE carriers 
      were identified; of these, 17 were part of two outbreaks. Before environmental 
      cleaning and disinfection, 55 (14%) environmental samples were VRE-positive. 
      Fifty-one isolates (23 patient samples and 28 environmental samples) were 
      available for WGS analysis. Forty-four isolates were assigned to ST117-vanB, five 
      were assigned to ST17-vanB, and two were assigned to ST80-vanB. Isolates from 
      Outbreak 1 (N=22) and Outbreak 2 (N=22) belonged to ST117-vanB; however, WGS 
      showed a different cluster type with 257 allelic differences. CONCLUSION: WGS of 
      two outbreak strains provided discriminatory information regarding genetic 
      relatedness, and rejected the hypothesis of a common environmental reservoir. A 
      high degree of environmental contamination was associated with higher VRE 
      transmission. Quantification of environmental contamination may reflect the 
      potential for VRE transmission and could therefore support the infection control 
      measures.
CI  - Copyright (c) 2021 The Healthcare Infection Society. Published by Elsevier Ltd. All 
      rights reserved.
FAU - Gast, K B
AU  - Gast KB
AD  - Microvida Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden 
      Hospital, Tilburg, The Netherlands. Electronic address: k.gast@etz.nl.
FAU - van Oudheusden, A J G
AU  - van Oudheusden AJG
AD  - Department of Infection Prevention, Elisabeth-TweeSteden Hospital, Tilburg, The 
      Netherlands.
FAU - Murk, J L
AU  - Murk JL
AD  - Microvida Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden 
      Hospital, Tilburg, The Netherlands.
FAU - Stohr, J J J M
AU  - Stohr JJJM
AD  - Microvida Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden 
      Hospital, Tilburg, The Netherlands.
FAU - Buiting, A G
AU  - Buiting AG
AD  - Microvida Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden 
      Hospital, Tilburg, The Netherlands; Department of Infection Prevention, 
      Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
FAU - Verweij, J J
AU  - Verweij JJ
AD  - Microvida Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden 
      Hospital, Tilburg, The Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20210211
PL  - England
TA  - J Hosp Infect
JT  - The Journal of hospital infection
JID - 8007166
RN  - 6Q205EH1VU (Vancomycin)
SB  - IM
MH  - *Cross Infection/epidemiology
MH  - Disease Outbreaks
MH  - *Enterococcus faecium/genetics
MH  - *Gram-Positive Bacterial Infections/epidemiology
MH  - Hospitals, Teaching
MH  - Humans
MH  - Multilocus Sequence Typing
MH  - Netherlands
MH  - Vancomycin
MH  - *Vancomycin-Resistant Enterococci/genetics
OTO - NOTNLM
OT  - Cleaning
OT  - Disinfection
OT  - Environmental sampling
OT  - Outbreak
OT  - Vancomycin-resistant enterococci
OT  - Whole-genome sequencing
EDAT- 2021/02/15 06:00
MHDA- 2021/08/05 06:00
CRDT- 2021/02/14 20:27
PHST- 2020/12/17 00:00 [received]
PHST- 2021/02/02 00:00 [revised]
PHST- 2021/02/04 00:00 [accepted]
PHST- 2021/02/15 06:00 [pubmed]
PHST- 2021/08/05 06:00 [medline]
PHST- 2021/02/14 20:27 [entrez]
AID - S0195-6701(21)00063-3 [pii]
AID - 10.1016/j.jhin.2021.02.007 [doi]
PST - ppublish
SO  - J Hosp Infect. 2021 May;111:132-139. doi: 10.1016/j.jhin.2021.02.007. Epub 2021 
      Feb 11.